Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO(®) CT scanner.

PURPOSE: Current solutions for navigated spine surgery remain hampered by restrictions in surgical workflow as well as a limited versatility and applicability. Against this background, we report the first experience of navigated spinal instrumentation with the mobile AIRO(®) intraoperative computed tomography (iCT) scanner. METHODS: AIRO(®) iCT was used for navigated posterior spinal instrumentation of 170 screws in 23 consecutive patients operated on in our Department between the first use of the system in May 2014 and August 2014. The indications for AIRO(®) were based on the surgical region, anatomical complexity and the need for >3 segment instrumentation. Following navigated screw insertion, screw positions were confirmed intraoperatively by a second iCT scan. CT data on screw placement accuracy were retrospectively reviewed and analyzed by an independent observer. RESULTS: AIRO(®)-based spinal navigation was easy to implement and successfully accomplished in all patients, adding around 18-34 min to the net surgery time. A systematic description of the authors' approach, setup in the OR and workflow integration of the AIRO(®) is presented. Analysis of screw placement accuracy revealed 9 (5.3%) screws with minor pedicle breaches (<2 mm). A total of 7 screws (4.1%) were misplaced >2 mm, resulting in an accuracy rate of 95.9%. CONCLUSIONS: The AIRO(®) system is an easy-to-use and versatile iCT for navigated spinal instrumentation and provides high pedicle screw accuracy rates. Although the authors' experience suggests that the learning curve associated with AIRO(®)-based spinal navigation is steep, a systematic user-based approach to the technology is required.

Trans-Sector Integrated Treatment in Psychosis and Addiction.

BACKGROUND: Patients with psychosis often develop comorbid addiction, with a lifetime prevalence of ca. 50%. Dual diagnoses are considered hard to treat. Long-term integrated treatment programs might improve such patients' outcomes, at least to a moderate extent, but they have not yet been adequately studied or implemented in Germany to date. METHODS: 100 dual diagnosis patients participated in a single-center, randomized, controlled trial under standard hospital treatment conditions. They were randomly allotted to two groups. Patients in the intervention group were admitted to a specialized open hospital ward, where they were given integrated treatment, including disorder-specific group therapy. Their treatment was continued with further disorder-specific group therapy in the outpatient setting. Patients in the control group were admitted to an open general psychiatric ward and received treatment as usual, but no disorder-specific treatment either during their hospitalization or in the subsequent outpatient phase. Follow-up examinations were performed three, six, and twelve months after inclusion. The primary outcome was defined as the changes in substance use and abstinence motivation. The secondary outcome consisted of the patients' satisfaction with treatment and with life in general, retention rate, psychopathology, rehospitalizations, and global level of functioning. RESULTS: The patients in the intervention group developed higher abstinence motivation than those in the control group (p = 0.009) and transiently reduced their substance use to a greater extent (p = 0.039 at three months). They were also more satisfied with their treatment (group effect: p = 0.011). Their global level of functioning and their retention rate were also higher, but these differences did not reach statistical significance. CONCLUSION: Low-threshold, motivational, integrated treatment programs with psycho-educative and behavioral therapeutic elements may be helpful in the treatment of dual diagnosis patients and should be more extensively implemented as part of standard hospital treatment. Larger-scale, methodologically more complex studies will be needed to identify subgroups of patients that respond to such treatments in different ways.

"Gratitude is with me all the time": how gratitude relates to wisdom.

OBJECTIVES: This study investigated the relationship of gratitude to wisdom. Both constructs are conceptually related to self-reflectivity, but they differ in their emphasis on extrapersonal resources. Previous wisdom research has focused mainly on intrapersonal capacities. METHOD: In Study 1, 47 wisdom nominees and 47 control participants were interviewed about their most difficult and best life event and filled out a questionnaire on sources of gratitude. Study 2 was a quantitative study (N = 443) of the relationship between a wisdom scale and scale measures and individual sources of gratitude. RESULTS: Significantly more wisdom nominees expressed feelings of gratitude spontaneously in their interview. Wisdom nominees reported gratitude for their life in general, religion, and partner more often than control participants. In Study 2, wisdom was related to all gratitude scales and to similar sources of gratitude as in Study 1. Both studies found gender differences in gratitude but not wisdom. DISCUSSION: Two important implications of these findings are that wisdom entails an appreciation of life and its experiences, especially the growth opportunities that may result from negative events, and that there may be substantial differences between male and female pathways to wisdom.

Reticulate evolution of the rye genome.

Rye (Secale cereale) is closely related to wheat (Triticum aestivum) and barley (Hordeum vulgare). Due to its large genome (~8 Gb) and its regional importance, genome analysis of rye has lagged behind other cereals. Here, we established a virtual linear gene order model (genome zipper) comprising 22,426 or 72% of the detected set of 31,008 rye genes. This was achieved by high-throughput transcript mapping, chromosome survey sequencing, and integration of conserved synteny information of three sequenced model grass genomes (Brachypodium distachyon, rice [Oryza sativa], and sorghum [Sorghum bicolor]). This enabled a genome-wide high-density comparative analysis of rye/barley/model grass genome synteny. Seventeen conserved syntenic linkage blocks making up the rye and barley genomes were defined in comparison to model grass genomes. Six major translocations shaped the modern rye genome in comparison to a putative Triticeae ancestral genome. Strikingly dissimilar conserved syntenic gene content, gene sequence diversity signatures, and phylogenetic networks were found for individual rye syntenic blocks. This indicates that introgressive hybridizations (diploid or polyploidy hybrid speciation) and/or a series of whole-genome or chromosome duplications played a role in rye speciation and genome evolution.

Extra-intracranial standard bypass in the elderly: perioperative risk, bypass patency and outcome.

BACKGROUND: Patients with chronic atherosclerotic vessel occlusion and cerebrovascular hemodynamic insufficiency may benefit from extra-intracranial (EC-IC) bypass surgery. Due to demographic changes, an increasing number of elderly patients presents with cerebrovascular hemodynamic insufficiency. So far, little data for EC-IC bypass surgery in elderly patients suffering occlusive cerebrovascular disease are available. We therefore designed a retrospective study to address the question whether EC-IC bypass is a safe and efficient treatment in a patient cohort ≥70 years. METHODS: 50 patients underwent EC-IC standard bypass surgery with translocation of the superficial temporal artery to an M2 segment of the medial cerebral artery. Criteria for bypass surgery were presence of symptomatic occlusive cerebrovascular disease of the anterior circulation and proof of a severely restricted or abrogated reserve capacity (detected by H2O-photon emission tomography or single photon emission computer tomography - before and after forced vessel dilatation by diamox). The incidence of perioperative neurological and surgical complications, bypass patency, bypass function and short-term outcome were retrospectively analyzed. RESULTS: The study cohort consisted of 16 patients ≥70 years (mean = 74.3 years, SE 1.3). It was compared to a cohort of 34 patients <70 years (mean = 61.2 years, SE 1.0). Both groups underwent EC-IC bypass surgery after careful preoperative work-up. Both patient groups did not differ significantly in gender, vascular pathology, previous history of diseases/comorbidity or clinical symptoms. The number of patients which underwent stenting or other endovascular treatments of the internal or common carotid artery prior to EC-IC bypass surgery was significantly higher in the group of patients ≥70 years (37.5 vs. 0%, p < 0.001). Perioperative stroke rate was 0% in both groups and mild morbidity occurred in 18.8 and 14.7%, respectively (p = 0.699). One 84-year-old female patient died due to perioperative endocarditis. Initial bypass patency was 93.8% in patients above the age of 70 years and 97.1% in the younger group (p = 0.542). Secondary occlusion rate was low in both groups (≥70 years: 0% vs. <70 years 3.7%). No new neurologic deficit occurred in patients with a patent bypass during the follow-up period (median 18 ± 13.1 months). Two patients with an initially occluded bypass and one with a secondary bypass occlusion suffered from new neurological symptoms. CONCLUSIONS: Our data show comparable safety and efficiency of EC-IC bypass surgery in patients under and above the age of 70 years due to a careful preoperative work-up and a strict indication for bypass surgery.

How to measure wisdom: content, reliability, and validity of five measures.

Wisdom is a field of growing interest both inside and outside academic psychology, and researchers are increasingly interested in using measures of wisdom in their work. However, wisdom is a highly complex construct, and its various operationalizations are based on quite different definitions. Which measure a researcher chooses for a particular research project may have a strong influence on the results. This study compares four well-established measures of wisdom-the Self-Assessed Wisdom Scale (Webster, 2003, 2007), the Three-Dimensional Wisdom Scale (Ardelt, 2003), the Adult Self-Transcendence Inventory (Levenson et al., 2005), and the Berlin Wisdom Paradigm (Baltes and Smith, 1990; Baltes and Staudinger, 2000)-with respect to content, reliability, factorial structure, and construct validity (relationships to wisdom nomination, interview-based wisdom ratings, and correlates of wisdom). The sample consisted of 47 wisdom nominees and 123 control participants. While none of the measures performed "better" than the others by absolute standards, recommendations are given for researchers to select the most suitable measure for their substantive interests. In addition, a "Brief Wisdom Screening Scale" is introduced that contains those 20 items from the three self-report scales that were most highly correlated with the common factor across the scales.

Inhalation treatment with glutathione in patients with cystic fibrosis. A randomized clinical trial.

RATIONALE: Glutathione is the major antioxidant in the extracellular lining fluid of the lungs and depleted in patients with cystic fibrosis (CF). OBJECTIVES: We aimed to assess glutathione delivered by inhalation as a potential treatment for CF lung disease. METHODS: This randomized, double-blind, placebo-controlled trial evaluated inhaled glutathione in subjects with CF 8 years of age and older and FEV1 of 40-90% of predicted. Subjects were randomized to receive 646 mg glutathione in 4 ml (n = 73) or placebo (n = 80) via an investigational eFlow nebulizer every 12 hours for 6 months. MEASUREMENTS AND MAIN RESULTS: FEV1 (absolute values), both as pre-post differences (P = 0.180) and as area under the curves (P = 0.205), were the primary efficacy endpoints, and were not different between the glutathione group and the placebo group over the 6-month treatment period. Exploratory analysis showed an increase of FEV1 from baseline over placebo of 100 ml or 2.2% predicted; this was significant at 3 months, but not later. Subjects receiving glutathione had neither fewer pulmonary exacerbations, nor better scores for quality of life. Whereas increased glutathione and metabolites in sputum demonstrated significant delivery to the lungs, there was no indication of diminished oxidative stress to proteins or lipids, and no evidence for anti-inflammatory or antiproteolytic actions of glutathione supplemented to the airways. The adverse event incidence was similar between glutathione and placebo. CONCLUSIONS: Inhaled glutathione in the dose administered did not demonstrate clinically relevant improvements in lung function, pulmonary exacerbation frequency, or patient-reported outcomes. Glutathione delivery to the airways was not associated with changes in markers of oxidation, proteolysis, or inflammation. Clinical trial registered with www.clinicaltrials.gov (NCT00506688) and https://eudract.ema.europa.eu/index.html (EudraCT 2005-003870-88).

Laser speckle imaging allows real-time intraoperative blood flow assessment during neurosurgical procedures.

Currently, there is no adequate technique for intraoperative monitoring of cerebral blood flow (CBF). To evaluate laser speckle imaging (LSI) for assessment of relative CBF, LSI was performed in 30 patients who underwent direct surgical revascularization for treatment of arteriosclerotic cerebrovascular disease (ACVD), Moyamoya disease (MMD), or giant aneurysms, and in 8 control patients who underwent intracranial surgery for reasons other than hemodynamic compromise. The applicability and sensitivity of LSI was investigated through baseline perfusion and CO2 reactivity testing. The dynamics of LSI were assessed during bypass test occlusion and flow initiation procedures. Laser speckle imaging permitted robust (pseudo-) quantitative assessment of relative microcirculatory flow and standard bypass grafting resulted in significantly higher postoperative baseline perfusion values in ACVD and MMD. The applicability and sensitivity of LSI was shown by a significantly reduced CO2 reactivity in ACVD (9.6±9%) and MMD (8.5±8%) compared with control (31.2±5%; P<0.0001). In high- and intermediate-flow bypass patients, LSI was characterized by a dynamic real-time response to acute perfusion changes and ultimately confirmed a sufficient flow substitution through the bypass graft. Thus, LSI can be used for sensitive and continuous, non-invasive real-time visualization and measurement of relative cortical CBF in excellent spatial-temporal resolution.

Individual differences in wisdom conceptions: relationships to gratitude and wisdom.

Previous research has shown that most laypeople hold one of two typical conceptions of wisdom--a cognitive or an integrative conception. The current study extends previous research by including a qualitative assessment of people's views of what wisdom is and how it develops, and by relating wisdom conceptions are related to levels of wisdom and gratitude. A sample of 443 young adults rated the relevance of cognitive, reflective, and affective aspects for wisdom. Cluster analyses confirmed the two typical wisdom conceptions: a primarily cognitive view of wisdom and a view emphasizing the integration of cognition, reflection, and affect. The two groups also differed in freely-generated characteristics of wisdom and its development. Additionally, the integrative conception was more frequent in individuals with higher levels of gratitude and wisdom. In sum, laypeople's conceptions of wisdom vary along similar lines as those of wisdom psychologists.

[Case report: acute cardiac arrest 3 days after hemihepatectomy]. / Kasuistik--Akutes Kreislaufversagen 3 Tage nach Hemihepatektomie.

We report a patient who presents pulmonary embolism three days after right hemihepatectomy because of colorectal metastasis. During two hours of successful resuscitation 50mg rt-plasminogen-activator are administered. Unfortunately the patient develops bleeding complications: an intraabdominal bleeding needs to be operated twice; intracerebral bleeding is followed by intracerebral edema. After a very prolonged intensive care treatment of 55 days the patient is discharged to a neurologic recreation centre. One year later she is doing fine beside a little cognitive deficit.

Substitution of glutamine by pyruvate to reduce ammonia formation and growth inhibition of mammalian cells.

In mammalian cell culture technology glutamine is required for biomass synthesis and as a major energy source together with glucose. Different pathways for glutamine metabolism are possible, resulting in different energy output and ammonia release. The accumulation of ammonia in the medium can limit cell growth and product formation. Therefore, numerous ideas to reduce ammonia concentration in cultivation broths have been developed. Here we present new aspects on the energy metabolism of mammalian cells. The replacement of glutamine (2 mM) by pyruvate (10 mM) supported cell growth without adaptation for at least 19 passages without reduction in growth rate of different adherent commercial cell lines (MDCK, BHK21, CHO-K1) in serum-containing and serum-free media. The changes in metabolism of MDCK cells due to pyruvate uptake instead of glutamine were investigated in detail (on the amino acid level) for an influenza vaccine production process in large-scale microcarrier culture. In addition, metabolite profiles from variations of this new medium formulation (1-10 mM pyruvate) were compared for MDCK cell growth in roller bottles. Even at very low levels of pyruvate (1 mM) MDCK cells grew to confluency without glutamine and accumulation of ammonia. Also glucose uptake was reduced, which resulted in lower lactate production. However, pyruvate and glutamine were both metabolized when present together. Amino acid profiles from the cell growth phase for pyruvate medium showed a reduced uptake of serine, cysteine, and methionine, an increased uptake of leucine and isoleucine and a higher release of glycine compared to glutamine medium. After virus infection completely different profiles were found for essential and nonessential amino acids.

Amino acid analysis in mammalian cell culture media containing serum and high glucose concentrations by anion exchange chromatography and integrated pulsed amperometric detection.

The direct separation detection of amino acids by anion exchange chromatography with integrated pulsed amperometric detection was optimized for the analysis of typical mammalian cell culture broth samples. Existing gradient elution conditions were adapted, considering the additions of peptone (2 g/L) and 10 vol% fetal calf serum to the medium as well as changing concentrations of glucose from 5.5 g/L up to complete consumption. Samples had to be analyzed in two dilutions with water (1:33.3 and 1:200) due to the strongly varying amino acid concentrations in the samples as a result of the medium composition and cell metabolism. The method was validated in a linear working range for the most common amino acids (2.5-7.5 and 1.25-3.75 microM for cystine/cysteine with 15 microl injection volume). The relative standard deviation of the method for all amino acids was less than 5%, with detection limits of less than 0.6 microM and quantitation limits of less than 1.6 microM. As an example, data for the amino acid composition of different media used for the production of inactivated influenza vaccines in cell culture are shown.

[Connections between attachment prototypes and relationship patterns]. / Zum Zusammenhang von Bindungsprototypen und zentralen Beziehungsmustern.

Connections between attachment styles and relationship patterns are studied on 32 female psychotherapy patients. Our study gives first hints to a connection between attachment variables, assessed by the German version of the Adult Attachment Prototype Rating (AAPR) and predominant relationship patterns, assessed by the Core Conflictual Relationship Theme Method (CCRT) developed by Luborsky, if both methods are used independently. Subsamples according to the attachment styles show differences in CCRT variables.

[The connection between affective evaluation of recollected relationship experiences and the severity of the psychic impairment]. / Zum Zusammenhang zwischen der Valenz von Beziehungserfahrungen und der Schwere der psychischen Beeinträchtigung.

This study, carried out at three different university centers contributes to validating the valence dimension of the CCRT-method. Working on the state of the CCRT-research on affective evaluation of relationship narratives, the connection between the valence dimension of the responses from others (RO), responses of the self (RS) and the severity of the psychic disorder has been analysed with the help of two different samples (n = 266 resp. n = 32) taken from female patients. Both, therapists as well as patients themselves, evaluated the severity of the impairment similarly. The more the patients were impaired, the more negatively they describes both their own reactions and those of their interaction partners as shown in the relationship episodes.

[Empirical analysis of transference and relationship patterns--A single case study]. / Zur empirischen Erfassung von Ubertragung und Beziehungsmustern - Eine Einzelfallanalyse1.

In the present study a psychoanalytic therapy was assessed by the CCRT method for the first time. We used reformulated categories for CCRT scoring. The data analyses were based not only on the most frequent categories but on newly developed alternative strategies. We could determine specific relationship patterns with special objects reflecting aspects of the clinical concept of transference.